title: Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.
abstract: Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hontanilla
authors.affiliation: Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Marre
authors.affiliation: Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Cabello
mesh_terms: D000293:Adolescent; D000328:Adult; D005145:Face / Q000294:innervation; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery; D007091:Image Processing, Computer-Assisted; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods; D013497:Sural Nerve / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult